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Funds run low for health insurance in state ‘high-risk pools’

Tens of thousands of Americans who cannot get health insurance
because of preexisting medical problems will be blocked from a program
designed to help them because funding is running low.

Obama administration officials said Friday that the state-based
“high-risk pools” set up under the 2010 health-care law will be closed
to new applicants as soon as Saturday and no later than March 2,
depending on the state.

But they stressed that coverage for about 100,000 people who are now enrolled in the high-risk pools will not be affected.

“We’re
being very careful stewards of the money that has been appropriated to
us and we wanted to balance our desire to maximize the number of people
who can gain from this program while making sure people who are in the
program have coverage,” said Gary Cohen, director of the Department of
Health and Human Services’ Center for Consumer Information and Insurance
Oversight. “This was the most prudent step for us to take at this point
in time.”

The program, which was launched in summer 2010, was
always intended as a temporary bridge for the uninsured. But it was
supposed to last until 2014. At that point, the health-care law will
bar insurers from rejecting or otherwise discriminating against people
who are already sick, enabling such people to buy plans through the
private market.

From the start, analysts questioned whether the
$5 billion that Congress appropriated for the Pre-Existing Condition
Insurance Plan — as the program is called — was sufficient.

Initial
fears that as many as 375,000 sick people would swamp the pools and
bankrupt them by 2012 did not pan out. This is largely because, even
though the pools must charge premiums comparable to those for healthy
people, the plans sold through them are often expensive.

But it
was also because the pools are open only to people who have gone without
insurance for at least six months. The result is that, while only about
135,000 people have gotten coverage at some point, they are proving far
more costly to insure than predicted.

Many people who are
uninsured go untreated, exacerbating their medical problems. When they
finally do get coverage through a high-risk pool, they are in immediate
need of expensive care.

“What we’ve learned through the course of
this program is that this is really not a sensible way for the
health-care system to be run,” Cohen said.

Of the original $5
billion, about $2.36 billion remains available for the last three
quarters of 2013 — enough only to continue coverage for those already in
the pools, according to administration estimates.

The law gave
states the option of either administering their pools directly or
allowing federal authorities to operate them. In 27 states that have
chosen direct management, applications for new enrollment can be
accepted only through March 2. In 23 states and the District, where the
pools are operated by the federal government, only applications received
through Friday will be considered.

Obama administration officials
said they did not have estimates for how many more people would have
sought coverage through the pools beyond then. But Cohen said that new
enrollment has averaged about 4,000 people per month in the past several
months, suggesting that the figure could number in the tens of
thousands.

Asked why the administration has not requested
additional money from Congress to keep the program open — admittedly a
tough sell in the current political and budgetary environment — Cohen
said, “My responsibility is to work with the appropriation we have.”

About
129 millionpeople nationwide have a medical condition or prior illness
that would make it hard for them to buy their own insurance plan.

Large
numbers of them can and still do obtain full coverage through
employer-sponsored plans, which generally do not treat sick people
differently.

An additional 215,000 people are insured through
separate high-risk pools that 35 states fund through their own budgets —
although the policies often do not pay for treatment of the person’s
preexisting illness, only covering new illnesses the person may develop.

Between 9 million and 25 million people with preexisting conditions are uninsured, depending on the estimate.

Among
those stunned by Friday’s news was a 61-year-old Virginia woman who is
battling stage-four breast cancer. The woman, who asked to be identified
by her middle name, Joyce, because she wants to keep her illness
private, is self-employed and had bought her own insurance for years.

Late
in 2010, however, the insurer that Joyce was using pulled out of
Virginia. She was healthy at the time. But when she applied to other
companies, she was told that because she had been diagnosed with — and
successfully treated for — an earlier breast cancer, she was ineligible
for coverage.

Joyce said she was unaware of the high-risk pools at
the time and remained ignorant of the option even as she was diagnosed
with her current cancer. As the disease has progressed, the cost of her
treatment has skyrocketed. The latest expense, a 10-week course of
chemotherapy that she expects to total about $30,000, as well as
additional tests that could top $8,000, has forced her to dip into her
retirement savings.

It is only in the past several weeks that
Joyce learned of the high-risk pool, and she was on track to finalize
her application Sunday.

On Friday, she scrambled to get it in by
the unexpected new deadline. She said the computer system appeared to
accept her entries, but she will be on tender hooks until she finds out
for sure.

“I feel like the rug has been pulled out from under me,” Joyce said. “On every level, this is just beyond discouraging.”

That doesn't go into effect until 2014. PCIP was trying to bridge that gap. What do you suggest they do?

Quoting candlegal:

I guess if you say so.

Isn't this one of the reasons so many people supposedly wanted Obamacare, because all the people with pre-existing conditions were supposed to be able to be insured without being turned down anywhere? That doesn't seem to be happening.

Quoting brookiecookie87:

Yeah-How dare those people with pre-existing conditions want treatment and care.

They deserve to die because they are not rich. Only rich people deserve treatment and care.Everyone knows this.

Quoting candlegal:

I guess this is why insurance companies haven't wanted to take on all those pre existing conditions.

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